The GP diet: the missing ingredient in better health

RESEARCH shows that general practitioners are highly trusted as providers of nutrition advice. Despite this and the fact that medical appointments provide a perfect avenue to talk about diet, doctors are failing to either give nutrition advice or refer their patients to other parts of the health-care workforce that could help.

Nutrition is prominent in clinical guidelines created for GP use because it's the basis of good health as well as bad. But doctors are not only failing to give dietary advice, research published today in the Medical Journal of Australia shows they are also not screening for obesity, a risk factor for early mortality that's explicitly linked with diet.

Cutting through noise

A big part of the problem is social rather than medical: nutrition messages are inherently "noisy", with an abundance of specific - and often contradictory - advice available through advertising, media and well-intentioned family and friends. We're constantly hearing new messages about food from sources that lack credibility, and these messages create confusion about what it means to have a healthy diet.

GPs are in the ideal position to help people cut through "nutrition noise", encourage them to have a healthier diet and highlight what advice to trust.

Doctors know nutrition is important but giving nutrition advice has to contend with the competing priorities of often more pressing health-care needs. On top of this, many are uncertain about how effective they can be in helping people improve their diet.

But if they don't feel they have enough time during appointments, or enough nutrition knowledge or skills to provide their patients with the right advice, doctors can provide referrals to dietitians, or not-for-profit services that support healthy eating.

Patients report feeling confused about the role of different health professionals regarding nutrition, particularly dietitians and nutritionists. This too highlights a significant role for doctors in helping patients cut through "nutrition noise" by explaining what advice they can trust and where to find safe, evidence-based advice.

Nutrition education

Many doctors may not feel confident about giving nutrition advice because they are not well educated on the subject. Indeed, the amount of nutrition education provided to medical students and doctors has traditionally been viewed by educators and government bodies alike as inadequate. But attempts to change medical education by incorporating nutrition knowledge are happening both in Australia and abroad.

A team of Australian medical and nutrition professionals has developed competency standards outlining the expected level of nutrition knowledge and skills to be developed during medical training. The curriculum of any medical course can be compared to these standards to make necessary changes.

Further, evidence-based online education modules developed by international institutions, such as the Nutrition in Medicine course created by the University of North Carolina, can also be incorporated into existing course material. And independent international education groups such as the Need for Nutrition Education/Innovation Programme (NNEdPro) are starting to provide free or low-cost continuing education to all doctors, including general practitioners and hospital physicians, on the topic of nutrition.

Supporting GPs

There are three areas where GPs need support to provide safe, effective nutrition advice. First of all, they need encouragement to raise the topic of nutrition in every appointment. After all, every patient's health can be improved by a healthy diet.

A 2015 review found GPs can help patients improve their diet by providing simple, brief nutrition advice. But these studies were all interventions - that is, the doctors were instructed on the specific nutrition advice to provide, so they don't reflect real-life situations.

Given that some doctors are uncertain about how or when to raise the topic of nutrition, they should be encouraged to focus on initiating these discussions as a priority for all patients.

Second, patients themselves might be the answer to starting nutrition conversations; research shows the strongest predictor for nutrition being discussed in a consultation is a patient request for nutrition advice.

This means patients have to be proactive about their nutrition needs. And it highlights opportunities for targeted initiatives, such as prompting patients in waiting rooms to consider asking about nutrition in their upcoming consultation.

Finally, once the topic of nutrition has been raised, the key to effective care by GPs is a focus on supporting healthy changes in behaviour, rather than specific facts about foods or nutrients.

Promoting evidence-based guidelines, such as the Australian Guide to Healthy Eating, and encouraging patients through simple but consistent messages such as "it's important for your health to eat well" and "eating more fruits and vegetables would help your health" are likely to be the basis for effective care. Such statements demonstrate that GPs place importance on the foods patients eat, which is the key to motivating improvements in diet.

- Lauren Ball is NHMRC Early Career Research Fellow at Griffith University